title: Germ cell tumors of the head and neck: report from the MAKEI Study Group.
abstract: BACKGROUND
  Germ cell tumors (GCTs) of the head and neck region are rare but may pose significant problems for perinatal management as well as surgical and adjuvant therapy.
  
  
  METHODS
  Thirty-two prospectively reported patients from the German MAKEI studies (Maligne Keimzelltumoren) were analyzed with regard to perinatal management and long-term survival.
  
  
  RESULTS
  Twenty-three tumors were diagnosed around birth and four during the first 3 months of life. All were primarily diagnosed as teratomas, but in two tumors, yolk sac tumor (YST) foci were identified. Another pure teratoma was diagnosed at 12 months. Four tumors were diagnosed after the first year of life and showed YST as leading histology. Most neonates presented with huge tumors causing external airway obstruction. All tumors were resected (complete resection, 16/26 patients with complete surgical information; incomplete resection, 10/26 patients). Eight tumors including five of six YSTs were treated with chemotherapy. In total, six patients relapsed. Relapse rate was higher after incomplete (5/10 patients) than after complete resection (1/16 patients). Accordingly, more relapses were observed in pharyngeal than in neck tumors due to incomplete resection. Nevertheless, half of the patients with incomplete resection remained in remission. One patient with YST died after multiple relapses.
  
  
  CONCLUSIONS
  GCTs of the head and neck region require a multidisciplinary approach in specialized centers. Most patients with antenatal tumor growth are identified by ultrasound and delivered preterm by cesarian section. After delivery, immediate intubation and ventilation aim for respiratory stabilization, followed by elective resection. With this approach, outcome was favorable.
authors.affiliation: Clinic of Pediatrics, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Bernbeck
authors.forename: Dominik T
authors.initials: DT
authors.lastname: Schneider
authors.forename: Benedikt
authors.initials: B
authors.lastname: Bernbeck
authors.forename: Susanne
authors.initials: S
authors.lastname: Koch
authors.forename: Carmen
authors.initials: C
authors.lastname: Teske
authors.forename: Jürgen
authors.initials: J
authors.lastname: Lentrodt
authors.forename: Dieter
authors.initials: D
authors.lastname: Harms
authors.forename: Ulrich
authors.initials: U
authors.lastname: Göbel
authors.forename: Gabriele
authors.initials: G
authors.lastname: Calaminus
mesh_terms: D018240:Endodermal Sinus Tumor / Q000175:diagnosis / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D018743:Perinatal Care; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D015996:Survival Rate; D013724:Teratoma / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome